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LMCC > Psych > Flashcards

Psych Flashcards

1
Q

Anxiety diagnosis

A 
AND I C REST 
Anxious, worried
No control
Duration >6mo of 3 or more of: 
- Irritability
- Concentration impairment
- Restlessness
- Energy decreased 
- Sleep impairment 
- Tension in muscles
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2
Q

GAD-7 scores

A 
5 = mild
10 = moderate
15 = severe
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3
Q

Best evidence-based treatment for anxiety

A

Cognitive behavioural therapy

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4
Q

Main brain structure involved in anxiety

A

Amygdala

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5
Q

Panic disorder diagnosis

A 
STUDENTS FEAR the 3Cs
Sweating 
Trembling 
Unsteadiness/dizziness
Derealization/depersonalization 
Excessive heart rate 
Nausea 
Tingling 
SOB 
Fear of dying 
Chills, chest pain, choking
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6
Q

Treatment duration for panic disorder

A

Up to 1 year after symptoms resolve

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7
Q

Pharmacological choices for panic disorder

A

SSRIs
SNRIs
Benzos for short-term use
Often require higher doses for longer period of time than depression

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8
Q

Prognosis of panic disorder

A

6-10yrs post-treatment:
30% well
40-50% improved
20-30% no change or worse

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9
Q

Agoraphobia diagnosis

A 
Marked fear or anxiety about 2 or more of: 
- using public transport
- being in open spaces
- being in enclosed places
- standing in line or being in a crowd 
- being outside of home alone 
avoids these situations
situations provoke fear or anxiety 
lasting >/=6mo
Impairs functioning
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10
Q

First line pharmacological treatment for anxiety

A

SSRI and SNRIs

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11
Q

Second line pharmacological treatment for anxiety

A

Buspirone (TID dosing)

Bupropion

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12
Q

First line treatment for phobic disorders

A

CBT

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13
Q

Genetics and specific phobias

A

Tends to run in families

Blood-injection injury type phobias has high familial tendencies

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14
Q

Paroxetine

A

SSRI

  • Paroxetine (Paxil) 20mg daily (take in morning), increase by 10mg/d at 1 week intervals
    • Typically 20-50mg/d, but no greater benefit seen with doses >20mg
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15
Q

Sertraline

A

SSRI
* Sertraline (Zoloft) 25mg daily, increase by 25-50mg at intervals of >/= 1-2 wks
* Typically 50-150mg/d, max dose of 200mg/d
Safest in pregnancy and breastfeeding

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16
Q

Citalopram

A

SSRI

  • Citalopram (Celexa) 10mg daily, increase by 10mg at >/= 1 week intervals
    • Typically 40mg/d for adults = 60yrs and 20mg/d for adults >60yrs
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17
Q

Escitalopram

A

SSRI

  • Escitalopram (Cipralex) 10mg daily, increase >/=1 wk intervals
    • Max 20mg daily
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18
Q

Venlafaxine

A

SNRI

* Venlafaxine (Effexor) 37.5mg daily, increase by = 75mg/d increments at >/=4d intervals 
    * Typically increase to 75mg after 4-7d 
    * Typically 75-225mg daily, max 225mg/d
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19
Q

Duloxetine

A

SNRI

  • Duloxetine (Cymbalta) 60mg daily or 30mg daily, increase by 30mg increments at >/= 1wk intervals
    • Typically 60mg daily, max 120mg/d
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20
Q

Panic disorder associated with ___ in 50% of cases

A

Agoraphobia

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21
Q

Social anxiety disorder/social phobia is most commonly associated with

A

Substance abuse

1/2-3/4 of patients with SAD have co-occuring mental, drug or alcohol problems

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22
Q

Having social anxiety disorder increases your likelihood of depression by

A

~2-4x

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23
Q

Multiple personality syndrome and depersonalization has been strongly associated with

A

Hx of childhood sexual abuse

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24
Q

Nihilistic delusions

A

Belief that things do not exist; a sense that everything is unreal

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25
Q

Suicide risk factors

A 
SAD PERSONS
Sex (male) 
Age >60 
Depression
Previous attempts 
Ethanol abuse 
Rational thinking loss
Suicide in family 
Organized plan 
No spouse/support 
Serious illness
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26
Q

Most common psychiatric disorders a/w completed suicide

A

Mood (bipolar > depression)

Alcohol abuse

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27
Q

Schizoprehnia dx

A

2 or more of the following, for at least 1 month, with at least one being one of the first three:
-Delusions
-Hallucinations
-Disorganized speech
-Grossly disorganized or catatonic behaviour
-Negative symptoms
Continuous signs of disturbance persist for at least 6 months
Decreased level of fxn

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28
Q

Echopraxia

A

Imitates movements and gestures of others

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29
Q

Schizophrenia linked to…

A

Substance related disorders
Anxiety disorders
Reduced life expectancy secondary to medical comrbidities

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30
Q

Antipsychotics

A

Risperidone
Aripiprazole
Haloperidole
Paliperidone

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31
Q

Last resort antipsychotic

A

Clozapine

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32
Q

Schizophrenia tx duration

A

At least 1-2yrs after first episode

At least 5yrs after multiple episodes

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33
Q

Schizophreniform d/o

A

Same criteria is schizophrenia but for at least 1 month and <6months
Return to baseline
60-80% progress to schizophrenia

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34
Q

Sex differences for schizophrenia

A

Male = female
Female dx later in life with bimodal distribution
Men = 10-25y.o,
Women = 25-35y.o.

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35
Q

Schizophreniform d/o

A

Same criteria is schizophrenia but for at least 1 month and <6months
Return to baseline
60-80% progress to schizophrenia

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36
Q

Schizophreniform epidemiology

A

Common in young adults/teens
Men&raquo_space; women (5x)
Less common than schizo («1%)

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37
Q

Tx for schizophreniform d/o

A

Brief course of antipsychotic drugs (3-6mo)

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38
Q

Brief psychotic disorder

A 
One or more of the following, with at least one being one of the first three:
- Delusions
- Hallucinations
- Disorganized speech 
- Grossly disorganized behaviour 
More than 1d, less than 1 mo
Eventual return to premorbid level of functioning 
~50% go onto develop chronic psych
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39
Q

Schizoaffective d/o

A

Major mood eps CONCURRENT with Criterion A of schizo
Delusions/hallucinations for 2 or more weeks WITHOUT major mood eps during duration of illness
Major mood eps symptoms present for majority of total duration of active portions of illness

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40
Q

Schizoaffective epidemiology

A 
Bipolar = equal in men and women, more common in young 
Depression = 2x more common in females. more common in older
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41
Q

Schizoaffective tx

A

Tx appropriate symptoms
BPD –> mood stabilizers
Depression –> SSRIs
Psychotics –> antipsychotics

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42
Q

Delusional d/o

A

> /= 1 delusion for 1 month or longer
Do not meet criterion A of schizo
Fxn not markedly impaired
Mania or major depressive epis brief relative to duration of delusions

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43
Q

Most freq subtype of delusional d/o

A

Persecutory

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44
Q

Depression

A 
5 or more of the following symptoms for at least 2 weeks, with at least 1 being depression or decreased interest:
Suicidal thoughts 
Interest decrease 
Guilt 
Energy low 
Concentration difficulty
Appetite change
Psychomotor changes 
Sleep issues
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45
Q

Mania

A 
1 week period of elevated mood AND increased energy/goal-directed energy plus 3 of the following:
DIGFAST 
- Distractibility 
- Indiscretion 
- Grandiosity 
- Flight of ideas 
- Activity increased 
- Sleep decreased 
- Talkativeness
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46
Q

Hypomanic episode

A

Mania but duration is >/= 4d and severity is not enough to cause marked impairment in social or occupational functioning

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47
Q

Mixed features mood disorder

A

While meeting full criteria for major drepressive episode, pt has on most days >/=3 criteria for manic episode
OR while meeting full criteria for manic/hypomanic episode, ptient has on most days >/= 3 criteria for depressive episode

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48
Q

Major depressive disorder

A

Presence of a MDE
Not better accounted for by schizoaffective d/o, not superimposed on schizophrenia, schizphreniform, delusional or psychotic d/o
No hx of manic episode or hypomanic

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49
Q

Fastest and most effective tx for MDD

A

ECT

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50
Q

1st line pharmacotherapy for MDD

A

SSRI: Sertraline, Escitalopram
SNRI: Venlafaxine
NaSSA: Mirtazapine

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51
Q

Typical response to antidepressants

A

Physical symptoms improve at 2wk
Mood/cognition by 4wk
If no improvement after 4wk at highest tolerated therapeutic dosage –> alter regimen

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52
Q

Persistent depressive disorder

A 
Depressed mood for most of the day, for more days than not for >/= 2 yr 
Presence of >/=2 of: 
Sleep changes 
Eating changes 
Energy low 
Self-esteem low 
Poor concentration
Feelings of hoeplessness 
Never without these symptoms during the 2 yr period for >2mo
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53
Q

Primary treatment for persistent depressive disorder

A

Psychotherapy

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54
Q

Postpartum blues

A

Normal
No psychotropic meds needed
Transient (2-4d postpartum, up to 10d)
Mild depression, mood instability, anxiety, decreased concentration
Usually mild or absent: feeling of inadequacy, anhedonia, thoughts of harming baby, suicidal thoughts

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55
Q

Major depressive disorder with peripartum onset

Postpartum Depression

A

MDD with onset during pregnancy or within 4wk following delivery
Typically lasts 2-6mo
Residual symptoms can last up to 1yr

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56
Q

Tx of MDD with peripartum onset

A

Psychotherapy
SSRI (safe short-term while breastfeeding)
If symptoms severe, consider ECT

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57
Q

Bipolar I Disorder

A

At least one manic episode
Commonly accompanied by at least 1 MDE but not required for dx
Usually MDE first, manic episode 6-10yrs after
Average age of first manic episode = 32yo

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58
Q

Bipolar II Disorder

A

At least 1 MDE, 1 hypomanic episode and no manic episodes

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59
Q

Bipolar treatment: Mania

A

Lithium
Anticonvulsants (divalproex, carbamazepine)
Antipsychotics
ECT if resistant
*MONOTHERAPY WITH ANTIDEPRESSANTS SHOULD BE AVOIDED

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60
Q

Agent with proven efficacy in preventing suicide attempts and completions

A

Lithium

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61
Q

Bipolar treatment: Depression

A 
Lithium
Lurasidone (atypical antipsychotic) 
Quetiapine (atypical antipsychotic)
Lamotrigine (anticonvulsant) 
Antidepressants (only WITH mood stabilizer) 
ECT
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62
Q

Cyclothymia

A
  • At least 2yrs (1 yr in children/adolescents), numerous periods with hypomanic symptoms that do not meet criteria for hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for major depressive episode
  • Hasn’t been without symptoms for more than 2mo at a time
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63
Q

Panic Disoder

A 
Recurrent unexpected attacks - abrupt surge of fear or intense discomfort reaching peak within MINUTES during which time 4 or more of the following occur: 
STUDENTS FEAT THE 3 Cs
- Palpitations, pounding heart, high HR 
- Sweating 
- Trembling/shaking 
- Blurred vision 
- Light-headedness 
- Chills or heat sensations
- Paresthesias 
- Derealization
- Fear or losing control
- Fear of dying
- Sensation of SOB or smothering 
- Feelings of choking 
- CP or discomfort 
- Nausea 
At least one attack followed by 1 mo or more of one or both of:
- persistent corn or worry about more panic attacks or their consequences
-Significant maladaptive change in behaviour related to attacks
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64
Q

Tx for Panic d/o

A

CBT
SSRI
SNRI
Tx for up to 1yr after symptoms resolve to avoid relapse

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65
Q

Anxiety vs depression tx

A

Anxiety often requires tx for longer and at higher doses than depression

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66
Q

Agoraphobia

A 
At least 2 of more of the following: 
- fear of open spaces 
- fear of line ups
- fear of enclosed spaces 
- fear of public transport 
- fear of being outside of house alone 
Fear for 6mo or more
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67
Q

Phobic disorder

A

Marked and persistent (>6mo) fear that is excessive or unreasonable, cued by presence or anticipation of a specific object or situation

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68
Q

Social anxiety disorder

A

Marked and persistent (>6mo) fear of social or performance situations in which one is exposed to unfamiliar ppl or to possible scrutiny by others; fearing he/she will act in a way that may be humiliating or embarassing

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69
Q

Obsessive Compulsive disorder

A

Presence of obsessions, compulsions or both
Obsessions: Recurrent and persistent thoughts, urges, or images that are intrusive and unwanted, cause anxiety, individual attempts to ignore or suppress thoughts
Compulsions: repetitive behaviours or mental acts that individual feels driven to perform in response to obsession. Behaviours meant to prevent/reduce anxiety or prevent some dreaded event but they are not connected realistically

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70
Q

Risk factors for OCD

A 
Neuro dysfunction 
Family hx 
Adverse childhood experiences 
Exposure to traumatic events 
Group a strep infection (PANDAS)
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71
Q

Tx for OCD

A

CBT (exposure with response prevention)
SSRIs/SNRIs (12-16wk trials, higher dosages than used for depression), adjunctive antipsychotics (risperidone)
Clomipramine (TCA)

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72
Q

Body dysmorphic disorder

A

Preoccupation with >/=1 perceived flaws in physical appearance not observed by others
Repetitive behaviours or mental acts related to appearance

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73
Q

PTSD

A 
TRAUMA
Traumatic event 
Re-experience the event
Avoidance of stimuli associated with trauma
Unable to function 
More than a month
Arousal increased 
\+ negative alterations in cognition and mood
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74
Q

PTSD tx

A

Psychotherapy, CBT
SSRI
Prazosin (treating disturbing dreams and nightmares)
Adjunctive atypical antipsychotics (risperidone, quetiapine)
Eye movement desensitization and reprocessing (EMDR)

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75
Q

Adjustment disorder

A

Emotional or behavioural symptoms in response to an identifiable stressor(s) occurring within 3mo of onset of stressor(s)
Once stressor has terminated, symptoms do not persist for more than an additional 6mo

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76
Q

Adjustment disorder tx

A

Brief psychotherapy

Benzodiazepine for significant anxiety

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77
Q

Antipsychotic options for delirium tx

A

Low doses of haloperidol IV or IM

Risperidone, olaznapine

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78
Q

Dementia

A

Significant cog decline from previous performance in 1 or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor or social cognition) based on both individual/clinician/family and standardized testing

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79
Q

Most common form of dementia

A

Alzheimer’s

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80
Q

Classic feature of alzheimer’s

A

Predominantly memory and learning issues

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81
Q

Classic feature of Lewy body dementia

A

Recurrent soft visual hallucinations
Autonomic impairment (falls, hypotension)
EPS/Parkinsonian features (cogwheeling, bradykinesia, resting tremor)
Does not respond well to pharmacotherapy
Fluctuating degree of cognitive impairment

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82
Q

Classic feature of vascular disease

A

Focal neurological signs

Abrupt onset

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83
Q

Pharmacological therapy for dementia

A

Mild-severe dz: Indirect holinesterase inhibitors
Mod-severe dz: Non-competitive NMDA receptor antagonist
Low-dose antipsychotics

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84
Q

Cholinesterase inhibitors x3

A

Donepezil (Aricept)
Rivastigmine
Galantamine

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85
Q

NMDA receptor antagonist x 1

A

Memantine

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86
Q

Low dose antipsychotics that can be used for dementia behavioural symptoms

A

Risperidone

Quetiapine

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87
Q

MOCA score

A

26/30 or above is considered normal

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88
Q

Indications for ECT as 1st line tx

A 
Acute suicidal ideation
MDE with psychotic features
Tx resistant depression
Catatonia 
Prior favourable response 
Repeated med failures
Rapidly deteriorating physical status
During pregnancy
Patient choice
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89
Q

3 most common causes of dementia in pts over 65

A

Alzheimer’s
Vascular
Mixed vascular and Alzheimer’s

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90
Q

Hallmark neuropathology in alzheimer’s

A

Amyloid deposits
Neurofibrillary tangles
Neuronal loss esp in cortex and hippocampus
Synaptic loss

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91
Q

Hallmark neuropathology in frontotemporal dementia

A

Atrophy in frontotemporal regions

Neuronal pick bodies (masses of cytoskeletal elements) hence AKA Pick’s disease

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92
Q

Criteria for substance use disorder

A

PEC WITH MCAT

  • use despite Physical or Psychological problems
  • failures in important External roles (work/school/home)
  • Craving or strong desire to use substance
  • Withdrawal
  • continued use despite Interpersonal problems
  • Tolerance needing to use more substance to get same effect
  • use in Hazardous situations
  • More substance used or for longer period than intended
  • unsuccessful attempts to Cut down
  • Activities given up due to substance
  • excessive Time spent on using or finding substance
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93
Q

CAGE questionnaire

A

ever felt the need to Cut down on drinking
ever felt Annoyed at criticism of your drinking
ever felt Guilty about your drinking
Eye opener
Men: score >/= 2 is +ve
Women: score >/= 1 if +ve

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4
5
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94
Q

Drinking guidelines

A

Men: 3 or less/d (= 15/wk)
Women: 2 or less/d (= 10/wk)
Elderly: 1 or less/d

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95
Q

CIWA basic protocol

A

Diazepam PRN until CIWA <10
Thiamine x 3d
If >65 or hx of liver dz –> lorazepam instead
Haloperidol if hallucinations present or atypical antipsychotics (olanzapine, risperidone)

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96
Q

Wernicke-Korsakoff Syndrome

A

EtOH-induced amnestic disorders due to thiamine deficiency

97
Q

Wernicke’s encephalopathy

A 
Acute and reversible 
Triad of:
Oculomotor dysfunction (ie. nystagmus)
Gait ataxia 
Confusion 
Tx: Thiamine 100mg PO OD  x 1-2wk
98
Q

Korsakoff’s syndrome

A

Chronic and only 20% reversible with tx
Anterograde amnesia and confabulations
Can’t occur during acute delirium or dementia
Must persist beyond usual duration of intoxication/withdrawal
Tx: Thiamine 100mg PO BID/TID x 3-12mo

99
Q

Pharmacological tx for EtOH use disorder

A

Naltrexone
Acamprosate
Disulfiram

100
Q

Naltrexone

A

Opioid antagonist
Reduces high a/w EtOH, moderately effective in reducing cravings, frequency or intensity of EtOH binges
Long half life
Can be used while pt is still drinking

101
Q

Acamprosate

A

NMDA glutamate receptor antagonist
Useful in maintaining abstinence
Doesn’t help with decreasing cravings

102
Q

Disulfiram

A

Prevents oxidation of alcohol (blocks acetaldehyde dehydrogenase –> acetaldehyde accumulates –> toxic reaction = vomiting, tachycardia, death)
Prescribed only when tx goal is abstinence

103
Q

Naloxone/Narcan

A

Opioid antagonist
Used for life-threatening CNS/respiratory depression in opioid overdose
Short half-life
Induces opioid withdrawal symptoms

104
Q

Opioid-use disorder tx

A 
Methadone = opioid agonist 
Buprenorphine = mixed agonist-antagonist 
Suboxone = buprenorphine + naloxone
105
Q

ECG findings of cocaine OD

A

Prolonged QRS

106
Q

Cocaine OD tx

A

IV diazepam to control sz

Beta blockers NOT recommended b/c of risk from unopposed alpha-adrenergic stimulation

107
Q

Date rape drugs

A

GHB
Flunitrazepam (roofies)
Ketamine

108
Q

MDMA MOA

A

Acts on serotonergic and dopaminergic pathways

109
Q

Gamma hydroxybutyrate MOA

A

Biphasic dopamine response (inhihibition then release)

110
Q

Flunitrazepam (Roofies) MOA

A

Strong benzos

111
Q

Ketamine MOA

A

NMDA receptor antagonist

112
Q

Malingering

A

intentional production of false or exaggerated symptoms, motivated by secondary gain/external reward

113
Q

Factitious disorder

A

Intentional production or feigning of physical or psychological signs not motivated by secondary gain but may seek sympathy

114
Q

Conversion disorder

A

> /= 1 symptoms or deficits affecting voluntary motor or sensory function that mimic a neurological disorder (ie. local paralysis, double vision, sz)

115
Q

Depersonalization

A

Experiences of detachment from oneself, feelings of unreality, or being an outside observer to one’s thoughts, feelings, speech, and actions (can feature distortions in perception including time, as well as emotional and physical numbing)

116
Q

Derealization

A

Experiences of unreality or detachment with respt to surroundings

117
Q

Non-rapid eye movement sleep arousal disorders

A

Incomplete awakening from sleep
Complex motor behaviour without conscious awareness Amnesia regarding episodes
Includes symptoms of: sleep walking, sleep terrors

118
Q

Rapid eye movement sleep behaviour disorder

A

Arousal during sleep a/e vocalization and/or complex motor behaviours
Rapid orientation and alertness on awakening

119
Q

Gender dysphora

A

Distress from conflict btwn one’s experienced/expressgend denger and one’s assigned gender

120
Q

Anorexia nervosa

A
  1. intake/weight (energy intake less than requirements, weight less than expected/normal)
  2. fear/behaviour
  3. perception
121
Q

Reasons to admit for anorexia nervosa

A 
<65% standard body weight (<85% if teen)
Hypovolemia requiring IVF 
HR <40bpm 
Abnormal serum chemistry
Actively suicidal
122
Q

Refeeding syndrome

A

Severe shifts in fluid/lytes due to metabolic response of refeeding in severely malnourished pt
Hypophosphatemia
CHF
Cardiac arrhythmias
Delirium
Death
Tx: slow, supplemental phosphorus, close lyte follow, cardiac status

123
Q

Bulimia Nervosa

A

A. Recurrent epis of binge eating (eating more than a typical person would during that time and having a sense of lack of control over eating)
B. Recurrent inappropriate compensatory behaviour to prevent weight gain
C. A and B happen at least once a week for 3 mo
D. Self eval is influenced by body shape and weight
E. Disturbance does not occur exclusively during episodes of AN

124
Q

Russell’s sign

A

Knuckle callus from self-induced vomiting

125
Q

Bulimia vs anorexia for pharmaco meds

A

Bulimia has some evidence for SSRIs (ie. fluoxetine)

Meds of little value for anorexia

126
Q

Binge-eating disorder

A
  • Recurrent epis of binge eating
  • Epis associated with 3 or more of:
  • Eating more rapidly than normal
  • Eating alone b/c embarrassed
  • Feeling gross with oneself afterwards
  • Eating until uncomfortably full
  • Eating large amounts when not hungry
  • Marked distress regarding binge eating
  • Occurs ~1x/wk for 3mo
  • NOT associated with recurrent use of inappropriate compensatory behaviour
127
Q

Avoidant/restrictive food intake disorder

A

Eating disturbance to extent of persistent failure to meet appropriate nutritional and/or energy needs –> significant weight loss/growth failure and nutritional deficiencies
Does not involve disturbances in body image

128
Q

Important lytes in eating disorders

A

KPMg
potassium
Phosphate
Magnesium

129
Q

Cluster A Personality D/O

A

Odd or eccentric cluster
Paranoid
Schizoid
Schizotypal

130
Q

Personality D/O with familial associations

A

Schizotypal
Antisocial
Borderline

131
Q

Paranoid Personality D/O

A 
4 or more of: 
SUSPECT 
- Spousal infidelity suspected 
- Unforgiving 
- Suspicious that others are exploiting or deceiving them
- Perceives attacks on character, counterattacks quickly 
- Enemy or friend? 
- Confiding in others is feared 
- Threats perceived in benign events
132
Q

Schizotypal Personality D/O

A 
Acute discomfort with and reduced capacity for close relationships and cognitive or perceptual distortions and eccentricities of behaviour
5 or more of: 
ME PECULIAR 
- Magical thinking
- Experiences unusual perceptions
- Paranoid ideation
- Eccentric behaviour/appearance 
- Constricted or inappropriate affect 
- Unusual thinking/speech
- Lacks close fiends 
- Ideas of reference
- Anxiety in social situations
- Rule out psychotic or pervasive developmental d/o
133
Q

Schizoid personality d/o

A

Detachment from social relationships and restricted range of expression of emotions in interpersonal settings
4 or more of DISTANT
-Detached/flat affect, emotionally cold
-Indifferent to praise or criticism
-Sexual experiences of little interest
-Tasks done solitarily
-Absence of close friends
-Neither desires not enjoys close friendships (including family)
-Takes pleasure in few activities (if any)

134
Q

Cluster B Personality Disorders

A 
Dramatic, emotional, erratic cluster 
Antisocial 
Borderline 
Histrionic 
Narcissistic
135
Q

Borderline Personality D/O

A 
Instability of interpersonal relationships, self image and affects, marked impulsivity 
5 or more of: 
DESPAIRER 
- Disturbance of identity 
- Emotionally labile 
- Suicidal behaviour 
- Paranoia or dissociation
- Abandonment (fear of) 
- Impulsive in at least 2 areas that are self-damaging 
- Relationships unstable 
- Emptiness (feelings of)
- Rage (inappropriate) 
Tends to fizzle out as pts age 
10% suicide rate
136
Q

Narcissistic PD

A 
Grandiosity, need for admiration and lack of empathy 
5 or more of : 
GRANDIOSE 
- Grandiose
- Requires attention
- Arrogant 
- Need to be special 
- Dreams of success and power 
- Interpersonally exploitative 
- Others (unable to recognize needs of)
- Sense of entitlement
- Envious
137
Q

Antisocial PD

A 
Disregard for and violation of rights others since 15y.o. 
3 or more of: 
CORRUPT 
- Cannot conform to law 
- Obligations ignored 
- Reckless disregard for safety
- Remorseless
- Underhanded (deceitful) 
- Planning insufficient (impulsive)
- Temper (irritable and aggressive) 
Must be at least 18 
A/W conduct d/o with onset before age 15
138
Q

Histrionic personality d/o

A

Excessive emotionality and attention seeking
5 or more of:
PRAISE ME
- Provocative or seductive behaviour
- Relationships considered more intimate than they are
- Attention (need to be centre of)
- Influenced easily
- Style of speech (lacking detail, impressionistic)
- Emotions (rapidly shifting, shallow)
- Make up (physical appearance)
- Emotions exaggerated

139
Q

Familial association of cluster B personality disorders with

A

Mood disorders

140
Q

Familial association of cluster C personality disorders with

A

Anxiety disorders

141
Q

Cluster C Personality Disorders

A

Anxious, fearful cluster
Avoidant
Dependent
Obsessive-compulsive

142
Q

Avoidant Personality Disorder

A

Social inhibition, inadequacy and hypersensitivity to negative evaluation
4 or more of:
CRINGES
-Criticism or rejection preoccupies thoughts in social situations
-Restraint in relationships d/t fear of shame
-Inhibited in new relationships
-Needs to be sure of being liked before engaging socially
-Gets around occupational activities with need for interpersonal contact
-Embarassment prevents new activity
-Self-viewed as unappealing or inferior

143
Q

Obsessive compulsive personality disorder

A 
Orderliness, perfectionism and mental and interpersonal control 
4 or more of: 
SCRIMPER 
- Stubborn
- Cannot discard worthless objects
- Rule obsessed 
- Inflexible
- Miserly 
- Perfectionistic 
- Excludes leisure d/t devotion to work
- Reluctant to delegate to others
144
Q

Dependent personality disorder

A

Submissive and clinging behaviour and fears of separation
5 or more of:
RELIANCE
- Reassurance required
- Expressing disagreement difficult
- Life responsibility assumed by others
- Initiating projects difficult
- Alone
- Nurturance (goes to excessive lengths to obtain)
- Companionship sought urgently when relationship ends
- Exaggerated fears of being left to care for self

145
Q

Attachment types

A

Secure
Insecure avoidant
Insecure ambivalent/resistent
Disorganized

146
Q

Secure attachment style

A

Healthy, good enough parenting
Child learns that they will get attention when they need help
60% of children
Mentally healthy adolescents and adults

147
Q

Insecure - avoidant attachment style

A

Emotionally rejecting parenting style
Child learns they will not receive attention when they need help and try to avoid expressing distress/do not seek parents for help
20% of children
May be at higher risk of behaviour d/o
Emotionally inhibited adults but still live fulfilling lives

148
Q

Insecure - ambivalent attachment style

A

Inconsistent parenting
Seek caregiver for help but difficult to soothe
Show increased distress in face of stressors
More problems in relationships as teens/adults
Increased risk of future psych d/o (esp anxiety)

149
Q

Disorganized-inhibited or disinhibited attachment style

A

Scary or fearful caregiver
Unable to organize strategy for seeking help
Inhibited –> child won’t go to anyone for help –> reactive attachment d/o
Disinhibited –> child will go to anyone for help –> disinhibited social engagement d/o
HIGHEST RISK for later developing psychopathology

150
Q

Disruptive mood dysregulation disorder

A

Severe developmentally inappropriate recurrent verbal or behavioural temper outbursts at least 3x/wk
Symptom onset before age 10, lasts for 12mo with no more than 3 consecutive mo free from symptoms
Supersedes dx of ODD if both criteria are met

151
Q

Bipolar d.o in teens

A

Higher proportion have mixed presentation and psychotic symptoms

152
Q

Autism spectrum Disorder

A

Persistent deficits in social communication and interaction manifested in 3 areas:
1. social-emotional reciprocity
2. Non-verbal communicative behaviours
3. Developing, maintaining and understanding relationships
Restricted, repetitive patterns of behaviour manifested by 2 or more of: stereotyped or repetitive motor movements, insistence on sameness, restricted fixated interests, hyper/hyporeactivity tosensory input

153
Q

ADHD

A

A. Inattention AND/OR hyperactivity-impulsivity that interferes with fxning or development
- Inattention: 6 or more of (for at least 6 months)
* Fails to pay close attention to details
* Difficulty staying focused
* Does not listen when spoken to
* Doesn’t follow instructions
* Avoids tasks that requires sustained mental effort
* Loses things necessary for tasks
* Easily distracted by extraneous stimuli
* Forgetful in daily activities
- Hyperactivity and impulsivity: 6 or more of (for at least 6months) or 5 or more if older teen/adult
* Fidgets with or taps hands/feets
* Leaves seat when not supposed to
* runs or climbs a lot/feels restless
* unable to play or engage in leisure activities quietly
* On the go, acting as if driven by motor
* talks excessively
* blurbs out answers
* can’t wait his/her turn
* interrupts or intrudes on others
Symptoms present before age 12
Symptoms present in 2 or more settings

154
Q

ADHD - 1st line pharmacologic tx

A

CNS STIMULANTS

  • Methylphenidate
  • Dextroamphetamine
  • Dextroamphetamine and amphetamine salt combos
155
Q

Methylphenidate

A

Ritalin, Concerta, Biphentin (small granules that can be sprinkled into food)
Dopamine AGONIST

156
Q

Dextroamphetamine

A

Dexedrine, Vyvanse

Dopamine AGONIST

157
Q

Dextroamphetamine and amphetamine salt combos

158
Q

ADHD - 2nd line pharmacologic tx

A

Atomoxetine (Straterra) - NE reuptake inhibitor

159
Q

ADHD 3rd line pharacologic tx

A

Adjunct nonstimulants (ie. guanfacine, clonidine. buproprion)

160
Q

Oppositional defiant disorder

A 
M=F after puberty 
At least 6mo 
at least 4 symptoms from any of the categories when interacting with at least 1 person who is not a sibling:
- Angry or irritable mood 
- Argumentative/defiant behaviour 
- Vindictiveness 
ODD kids ARE BRATS
Annoying 
Resentful
Easily annoyed 
Blames others 
Rule breakers 
Argues with adults 
Temper 
Spiteful/vindictive
161
Q

Conduct disorder

A 
M:F = 4-12:1 
>/=3 criteria in past 12mo and >/=1 in past 6mo
TRAP 
Theft 
Rule breaking 
Aggression
Property destruction 
If >18yo, consider antisocial PD
162
Q

Intermittent Explosive Disorder

A

Recurrent behavioural outbursts representing failure to control aggressive impulses in children age >/= 6 manifested as either
verbal or physical aggression >/=2x/wk for 3mo
3 outbursts involving physical damage to another person, animal, piece of property in last 12mo

163
Q

Mesolimbic DA pathway and schizophrenia

A

High DA causes positive symptoms of schizophrenia

164
Q

Mesocortical DA pathway and schizophrenia

A

Low DA causes negative symptoms of schizophrenia

165
Q

Nigrostriatal DA pathway and schizophrenia

A

Low DA causes EPS

166
Q

Tuberoinfundibular DA pathway and schizophrenia

A

Low DA causes hyperprolactinemia

167
Q

Typical antipsychotic MOA

A

Block postsynaptic DA receptors (D2 )

168
Q

Atypical antipsychotic MOA

A

Block postsynaptic DA receptors AND serotonin (5HT2) or presynaptic dopaminergic terminals, triggering DA release and reversing DA blockade in some pathways

169
Q

Common typical antipsychotics

A

Haldol
Fluphenazine
Loxapine

170
Q

Common atypical antipsychotics

A 
Risperidone 
Paliperidone 
Olanzapine 
Aripiprazole 
Quetiapine (seroquel)  
Clozapine
171
Q

Most effective antipsychotic for tx resistant schizophrenia

172
Q

Antipsychotic with hghest risk of EPS

A

Risperidone

173
Q

Neuroleptic malignant syndrome

A

Due to strong DA blockade
Mental status changes then fever, autonomic reactivity, rigidity
Develops over 25-72h

174
Q

Neuroleptic malignant syndrome labs

A

Elevated creatine phosphokinase
Leukocytosis
Myoglobinuria

175
Q

Neuroleptic malignant syndrome tx

A 
Supportive 
D/C antipsychotic 
Hydration
Cooling blankets
Dantrolene (muscle relaxant) 
Bromocriptine (DA agonist)
176
Q

Dystonia

A

Acute or tardive
Sustained abnormal posture, torsions, twisting, contraction of muscle groups
Tx: Benztropine or diphenhydramine (anticholinergics)
IV if severe, PO if mild

177
Q

Akathisia

A

Acute or tardive
Motor restlessness, crawling sensation in legs
Tx: Lorazepam, propranolol or diphenhydramine

178
Q

Pseudoparkinsonism

A

Acute only
Tremor, rigidity (cogwheeling), akinesia, postural instability
Tx: Benzotropine or amantadine (NMDA antagonist, DA reuptake inhibitor)

179
Q

Dyskinesia

A

Tardive only
Purposeless, constant movements involving facial and mouth musculature
Tx: No good tx, may try clozapine
DO NOT give anticholinergics, may worsen the condition

180
Q

Anticholinergics and EPS

A

Do not routinely rx with antipsychotics

Rx only if at high risk for acute EPS or if acute EPS develops

181
Q

Fluoxetine

A

Prozac
Most activating SSRI (recommend taking in AM)
Does NOT require taper due to long half-life
Most useful in children

182
Q

Wellbutrin

A

Bupropion
Starting dose 100mg
Therapeutic dose 300-450
NDRI (NE and DA)
Pros: no weight gain or sexual dysfunction
Cons: Sz at high doses
C/I: Seizure disorders, bulimia nervosa, anorexia nervosa, MAOI use in psat 2 wks

183
Q

Amitriptyline

A

TCA

Useful for OCD

184
Q

MAOI

A

Phenelzine
Useful for moderate/severe depression that doesn’t respond to other antidepressants
Needs MAOI diet (avoid foods with tyramine - cheese, cured meats, aged soy, overripe fruits, EtOH)
Tyramine metabolism is inhibited by MAOI –> sympathomimemtic response (HTN crisis)

185
Q

Mirtazapine

A

NaSSA
Useful for depression with prominent features of insomnia, agitation or cachexia
Does not cause appetite suppression
Infrequently causes sexual disturbance

186
Q

Anticholinergic S/E

A 
Mad as a hatter
Red as a beet 
Blind as a bat 
Dry as a bone 
Hot as a hare
187
Q

Serotonin syndrome

A

Due to over-stimulation of serotonergic system
Nausea, diarrhea, palpitations, chills, restlessness, confusion, lethargy –> myoclonus, hyperthermia, rigor and hypertonicity

188
Q

Discontinuation syndrome

A

Most commonly with paroxetine, fluvoxamine, venlafaxine

189
Q

Common mood stabilizers

A 
1st line: 
Lithium 
Lamotrigine 
Divalproex 
2nd line:
Carbamazepine
190
Q

Lithium monitoring

A

Before starting: UA, BUN/Cr, thyroid function, ECG if heart disease
Serum levels every 5-7d until therapeutic (wait 12h post dose)
Then monitor monthly
Then q2-3mo
Monitor thyroid function, Cr q6mo and UA q1y

191
Q

Acute mania tx

A

Lithium
DIvalproex
Carbamazepine
NOT lamotrigine

192
Q

Lamotrigine monitoring

A

No therapeutic plasma level established, titrate based on response
Slow titration due to risk of SJS
A/E: SJS, fever, swollen glands, severe muscle pain, bruising, headache, neck stiffness, vomiting, confusion, increased sensitivity to light

193
Q

Divalproex monitoring

A

Monitor serum levels q5-7d until therapeutic

LFTs weekly x 1mo then monthly then q2-3mo due to risk of liver dysfunction

194
Q

Divalproex drug interaction

195
Q

Carbamazepine monitoring

A

Monitor serum levels q5-7d until therapeutic

Weekly blood counts for first month due to risk of agranulocytosis

196
Q

Carbamazepine drug interaction

197
Q

Lithium toxicity

A

Clinical dx as toxicity can occur at therapeutic levels
Caused by OD, fluid loss, concurrent illness, NSAIDs or diuretics
N/V/D, ataxia, slurred speech, poor coordination, polyuria, drowsiness, myoclonus, tremor, UMN signs, sz, delirium, coma
Tx: D/c for several days and restart at low dose when level falls to non-toxic range, saline infusion, hemodialysis if high levels, coma, shock, severe dehydration, failure to respond to tx after 24h or deterioration

198
Q

Benzo MOA

A

Strengthen binding of GABA to receptors –> decreased neuronal activity

199
Q

Benzo antagonist for OD

A

Flumazenil

200
Q

Buspirone MOA

A

Partial agonist of 5-HT1A receptors

201
Q

Benzodiazepines safe in pts with impaired liver function

A

LOT
Lorazepam
Oxazepam
Temazepam (should be avoided)

202
Q

ECT

A

Induction of generalized sz using electrical impulse through scalp electrodes while pt is under general anesthesia with muscle relaxant

203
Q

Repetitive transcranial magnetic stimulation (rTMS)

A

Focal electrical currents in select brain circuits using magnetic induction

204
Q

Form 1

A

Right to hospitalize pt for psych assessment against his/her will
Valid for 72h

205
Q

Form 2

A

Right to bring pt in for psych assessment against his/her will
Valid for 7d

206
Q

Form 3

A

Certificate of involuntary admission to facility
Completed by any MD other than MD who completed Form 1
Valid for 14d

207
Q

Form 4

A

Certificate of renewed involuntary admission
First: 1mo
Second: 2mo
Third: 3mo (Max)

208
Q

Form 5

A

Change to informal/voluntary staus

209
Q

Risperidone

A

Atypical antipsychotic of choice if wanting to avoid sedation

210
Q

Narcolepsy

A

Excessive daytime sleepiness
Cataplexy (emotion causes physical collapse)
Hypnagogic hallucinations
Sleep paralysis

211
Q

Narcolepsy tx

A

Methylphenidate and other stimulant drugs

212
Q

Tourette syndrome

A

Common genetic neuro disorder manifested by motor and phonic tics with childhood onset
Symptoms must occur for more than 1yr
Tics = involuntary, sudden, brief, intermittent movements or utterances that present with irresistible urge before and relief after

213
Q

Treatment for tics

A

Alpha2-adrenergic drugs (Clonidine, Guanfacine)
Antipsychotics (risperidone best studied)
Botox
Psychotherapy

214
Q

Antipsychotics and galactorrhea

A

DA RESTRICTS prolactin release
Antipsychotics decrease DA –> increased prolactin –> galactorrhea (+menstrual irregularities, infertility)
Most commonly seen with first gen antipsychotics (haldol, fluphenazine) and 2nd gen (risperidone and paliperidone)

215
Q

Somatic symptom disorder

A

At least 4 pain symptoms, GI distress, Sexual problems and pseudoneurological symptoms
Begins before age 30

216
Q

Bipolar tx duration

A

Indefinite tx with mood stabilizer

Kindling phenomenon = episodes occur more frequently, more severe and less responsive to tx if tx is stopped

217
Q

Early morning awakening - depression or anxiety?

A

Depression

218
Q

Difficulty falling asleep - depression or anxiety?

219
Q

Apprehensive expectations or feelings of dread - depression or anxiety?

220
Q

Voyeuristic disorder

A

Sexually aroused by watching someone who is disrobing, naked or engaged in sexual activity

221
Q

Exhibitionistic disorder

A

Involves exposing the genitals in order to become sexually excited or having strong desire to be observed by other ppl during sexual activity

222
Q

Transient tic disorder

A

AOO 7yo
Vocal and/or motor tics which occur several tism a day for a minimum of 4 wks, however, no logner than 12mo
Dx CANNOT be made if pt has EVER had a hx of Tourette’s

223
Q

Acute stress disorder

A

> /= 3d and =1mo following trauma

If >1mo, then becomes PTSD

224
Q

Most common S/E a/w Olanzapine

A

Weight gain

225
Q

Psych drug a/w diabetes insipidus

226
Q

Amenorrhea from prolactin elevation most commonly seen with

A

Palliperidone

Risperidone

227
Q

Atypical antipsychotic monitoring

A 
Metabolic adverse effects:
BMI 
Fasting plasma glucose 
Lipids 
BP
Waist circumference 
Baseline, at 3mo then annually
Olanzapine and clozapine pose greatest risk
228
Q

Lithium C/I

A

CKD –> use Valproate instead
Heart disease
Hyponatremia or diuretic use

229
Q

Common drugs affecting lithium levels

A 
Diuretics 
NSAIDs, EXCEPT ASA
SSRI
ACEi/ARB 
Antiepileptics
230
Q

Wellbutrin C/I in what medical condition

A

Epilepsy

Lowers sz threshhold

231
Q

Psych med known to cause hypothyroidism

A

Lithium
Baseline thyroid function tests should be mesaured prior to starting Li therapy and monitored 3mo after starting and 6-12mo thereafter

232
Q

Recurrence of depression

A

6x risk boys, 4x risk in girls
Recurrence more common with family hx
Mean # episodes over lifetime is 5-6

233
Q

Mean # episodes of bipolar over lifetime

234
Q

Indications for long-term tx of depression

A

2 depressive episodes within 5 years
3 prior episodes
Severe psychotic depression, serious suicide attempt
Review afte r3-5yrs

235
Q

Long-term tx depression

A

All antidepressants and lithium continued at dose to manage acute episode

236
Q

Management of hypertension in AD patients

A

Beta blockers

237
Q

Capgras Syndrome

A

Belief that someone familiar has been replaced by an imposter

238
Q

Catatonia treatment

A

Benzodiazepines

LMCC (22 decks)

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